Enteral feeding methods and surgical complications in children

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Background In the unwell child who is unable to feed orally, various methods for enteral feeding having been advocated. The ideal method for a particular child has to be tailored according to his/her anatomy, physiology and requirements. The impact of complex medical background on outcomes and complications following a surgical procedure in children remains largely unrecognized. Aims 1. To determine whether percutaneous endoscopic gastrostomy (PEG) is superior to radiologically inserted gastrostomy (RIG) 2. To determine outcomes following surgical jejunostomy (SJ) or radiologically inserted gastro-jejunal (RGJ) tube 3. To study complications after surgery and determine its effect Methods A double-blinded randomised controlled trial was conducted in children needing gastric feeding, who received either a PEG or RIG. They were followed up for up to 3 years to record any complication. Retrospective reviews of buried bumpers (a specific complication of gastrostomy), and the nutritional outcomes following jejunostomy placement (SJ or RGJ) was carried out. Available scoring systems for post-operative complications were reviewed and initial development of a new paediatric complexity scoring system was performed. Results In the trial 198 children were randomised (100 PEG and 98 RIG). They were followed up to a median of 1 year (6 weeks to 3 years). There was no difference between total number of complications or the rate of complications, following PEG or RIG. Both SJ and RGJ are able to maintain and improve growth in a carefully selected group of children. There is a need for validation of a developed paediatric complexity scoring system. Conclusions PEG and RIG have equivalent rates of complications. SJ and RGJ cannot be compared as they are used for patients at different stages in a spectrum of malnutrition. Impact of the complexity of paediatric patients on their post-operative complications needs thorough consideration to improve outcomes.

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